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Setting the Context For better of for worse psychodynamic theory is the most influential and comprehensive theory of human psychological development and functioning to date. – Flores (1997). Why do we need to understand psychodynamic theory with respect to conducting group therapy… 3Solowoniuk, 2007

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A prelude: Psychodynamic Theory and Addiction Addiction occurs in and amongst psychological development (ego or self development). First and foremost the self or “I” is created through the desire to be with others as oneself, with all its imperfections and its shortcomings, while recognizing that others are independent, separate and not just there to serve one’s own needs and desires…. OBJECT RELATIONS THEORY 4Solowoniuk, 2007

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Psychodynamic Theory: A Neo-Freudian Object Related Theory Freud held that behavior is determined by biological drive states that are tempered by social expectation (superego) and through a evolving rational self (ego). However; His successors (e.g., Kernberg, Mahler, Kohut, and Winnicott’s) work over 60 years holds that our sense of self is defined by the way we are perceived by others and how we perceive or distort our perceptions of others. 5Solowoniuk, 2007

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Neo-Freudian Philosophical Underpinnings Development of “Self” primary goal of human being. Thus, we become what we are in order to be able to develop authentic real relationships… And we remain inauthentic or false until we are able to engage another in true dialogue. The hook or problem is however… 6Solowoniuk, 2007

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Developmental Impasses We must first be autonomous and independent before we can fully engage each other. However, if we do not know our boundaries, we can lose ourselves in our relationships and confuse that which is ours with that which is not ours. Hence, “can I be close to another without losing myself and can I really tolerate being alone”? 7Solowoniuk, 2007

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Enter Addiction This is an important theme in the treatment of addiction because many persons for whom addiction is a problem feel at their core that: A) They don’t know who they are; B) Their history displays a rash of failed relationships or none all; C) They present as unworthy, unlovable, and; D) They either have rigid boundaries or none not at all 8Solowoniuk, 2007

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Enter Addiction (contd). Ultimately, a persons’ use of a drug or a behaviour is a way t0 combat their feelings of worthlessness while also burying a sense of emptiness that intermittently permeates their consciousness. And yet through extended use these phenomena only become more hauntingly real; leading to further escape via a false-self schema. http://video.google.ca/videoplay?docid=541156611257410240 3&q=Emptiness&total=1437&start=150&num=10&so=0&type =search&plindex=9 9Solowoniuk, 2007

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Enter Addiction (contd) Thus, addiction can represent or take the form of Yearning for praise and approval or a merger with an idealized other in order to self-sooth; or it can… Take the form sexual acting out with persons, figures, or symbols so as to feel wanted, real, alive, or powerful; or it can be … An escape through drugs into a fantasy world to keep the void and meaningless at bay. Yet whatever the means, according to… 10Solowoniuk, 2007

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Psychodynamic theory… All these behaviors are a substitute for a self-object which failed the infant/child when they should still have had the feeling of omnipotently controlling its responses in accordance with his or her needs as if it were part of themselves. 11Solowoniuk, 2007

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Towards An Object-Related Developmental Understanding of Addiction Self-Object: mental representations of others that we experience as part of ourselves; there are two types. Mirroring self-object: is a object that responds to and confirms the child’s innate sense of vigor, greatness, and perfection. For example: it is the gleam in the mother/father’s eye that is tune with the infant/child’s achievements. It is this pole that the child’s basic strivings for power and success emanate. 12Solowoniuk, 2007

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Mirroring Self-Object Therefore if the parents/caregiver/or other mirror these feelings to the ICA he or she develops a healthy sense of self with an appropriate sense of assertiveness and ambition. Failure of the self-object to optimally gratify the ICA’s hungry needs results in an individual who needs constant admiration, confirmation, and recognition from others because they are empty and cannot give this to themselves. http://video.google.com/videoplay?docid=- 2757068201635933659&q=Proud+%2B+toddler&total=45&start=0&num=10&so=0&type=search& plindex=5 http://video.google.com/videoplay?docid=8169159604168360620&q=Mirroring+%2B+mother+and+child&total=52&start=30&nu m=10&so=0&type=search&plindex=6 13Solowoniuk, 2007

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Idealizing Self-Object Idealizing self-objects are objects with whom a child can merge as an image of calmness, infallibility, and omnipotence. If the child is presented with a strong, soothing self-object who allows idealization, he or she develops a capacity for healthy ideals, values, and principles. In contrast, children who do not have idealizing self-objects available are forever attempting to achieve a union with an idealized object. http://video.google.com/videoplay?docid=6521317519421305512 14Solowoniuk, 2007

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Margaret Mahler’s Theory of Ego Development If one is to truly elucidate how ego development affects later life toward understanding addiction as relational (i.e., cure through ingesting objects/drugs or others)… Which leaves no psychic structure in place to appease a false-self schema, we must understand how a viable ego is formed or deformed. Consequently to begin investigating how an ego or “I” is birthed, we are brought to the work of Margaret Mahler and her theory of ego development. 15Solowoniuk, 2007

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Introducing: Margaret Mahler’s Theory of Ego Development After having spent most of her professional career studying severely disturbed children, Mahler began to investigate the psychological development of children (o – 3 years ). She eventually drew a picture of the psychological birth of the child, which stressed that the ego purposefully sought relations. Whereas Freud, believed the ego’s primary drive was to reduce biological urges. 16Solowoniuk, 2007

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Introducing: Margaret Mahler’s Theory of Ego Development (contd). Essentially, her work revealed the interpersonal relations of the ego and how these relations determined the building of future intrapsychic structures and in turn… How these structures preserve, modify, and reactive past relations throughout the lifespan. Most importantly, Mahler was able to delineate the birth and evolving births of important psychic structures from 0 to 3 toward the creation of a cohesive self/real self/true-self. 17Solowoniuk, 2007

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Stage I: Normal Autism (birth to 4 weeks) During the first month of life, the infant is encapsulated in a psychic orbit that serves as a stimulus barrier protecting the child from excessive outside intrusions. It is considered normal because of its an adaptive function, allows the child to purposefully use the mother as an auxiliary ego. If however, the environment is grossly pathological the early development of ego does not begin and fusion or less than optimal differentiation between mother, world, and child may result. 19Solowoniuk, 2007

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Normal Symbiosis – Attachment By the second month of life, the infant becomes aware of the mother/father/caregiver (MFC) as an external object. During these early months the infant internalizes the MFC and uses it as a beacon of orientation, engendering a basic sense of: 1. Security 2. Safety, and; 3. Trust 20Solowoniuk, 2007

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Splitting the Good and the Bad The crude differentiation between object and self, good and bad, and pleasure and pain allows the symbiotic infant to deal with painful experiences in the only way his/her limited cognitive defenses permit… **By splitting the good and the bad, and projecting the bad outside of the symbiotic partnership. Eventually this splitting will have to be reconciled… 21Solowoniuk, 2007

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Splitting the Good and the Bad (contd). Crucial to this development phase is the infant’s ability to attach itself to an eternal object. However, the failure of the attachment carries several deficits in the early organization of the self. However, we must keep in mind it’s not just the MFC’s that lead to attachment failure as both biology, personality, and environment play a role here. 22Solowoniuk, 2007

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Failure to Attach to External Other Failure here may lead to a ego or I that is Affectionless Withdrawn from interest in the world, self/other (engendering a basic mistrust) personality, or ; failure may lend its self to the… Creation of a False-Self 23Solowoniuk, 2007

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False Self / True-Self – Ala’ “Winnicott” In the event that the infant/child’s ego or I is threatened, defensive compensatory structures (false-self) are established to prevent further injury. Such an individual develops an as if personality bolstered by a pomposity that hides their “true self” from further fragmentation. But this defensive process prevents them from further nourishing their true self because each success is attributed to the way they “acted” rather than “who they are”. 24Solowoniuk, 2007

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False Self / True-Self – Ala’ “Winnicott” (contd) Consequently, they feel like “imposters” who sub-consciously ruminate about being discovered and exposed for what they really are. However, the therapist must understand that this false-self creation is a defense mechanism designed to hide and protect the true-self that lies within. Winnicott holds that false-self is not conceived as malevolent, on the contrary it is a caretaker self that energetically manages life so that an inner self might not experience the threat of annihilation resulting from excessive pressure on it to develop according to the internal logic of an another person (MFC). 25Solowoniuk, 2007

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Winnicott’s False/True-self Primary Tenets "With the care that it receives from its mother each infant is able to have a personal existence, and so begins to build up what might be called a continuity of being. On the basis of this continuity of being the inherited potential gradually develops into an individual infant. If maternal care is not good enough then the infant does not really come into existence, since there is no continuity of being; instead the personality becomes built on the basis of reactions to environmental impingement.“ "The first ego organization comes from the experience of threats of annihilation which do not lead to annihilation and from which, repeatedly, there is recovery." "(1) Subject relates to object. (2) Object is in process of being found instead of being placed by the subject in the world. (3) Subject destroys object. (4) Object survives destruction. (5) Subject can use object." 26Solowoniuk, 2007

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Winncottian Therapy For Winnicott, the therapist's task is to provide a holding environment for the client so they have the opportunity to meet neglected ego needs and allow their true self to emerge. One of the most important attributes of the therapist is simple patience. "If only we can wait, the patient arrives at understanding creatively and with immense joy...The principle is that it is the patient and only the patient who has the answers." 27Solowoniuk, 2007

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Returning to Mahler/Stage II: Separation Individuation Differentiation and Hatching (5 to 10 months) As strong as the child’s yearnings for attachment are, the infant gradually begins to experience even more powerful urges to move away from his/her MFC’s. - Hatching Such a phase marks the beginning of the child’s emergence as a separate individual free from the symbiotic attachment to his/her MFC’s. Failure to negotiate this developmental process results in an adult who becomes disorganized and suffers dissolution of the self when faced with object loss. 28Solowoniuk, 2007

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Failure of Differentiation When severe, the individual is unable to discern inner experiences from outer experiences, leading to confusion regarding what is me and what is not me. In extremer cases, internal stimuli become confused with external reality, which may be the breeding ground for hallucinations and delusions. These individuals may have an infinity for hallucinogen type drugs or similar behaviors. 29Solowoniuk, 2007

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Practicing From approximately 10 – to 15 months, the child’s focus shifts from the MFC’s to autonomous functioning. He/she begin to stand, walk, climb, jump, etc… He or she truly believes they are the center of the universe (primary narcissism). However, if the child is not given boundaries, or if boundaries are too rigid or diffuse, or the child process of development is impaired by unavailable, intrusive, or uncaring self-objects… 30Solowoniuk, 2007

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Grandiose Self A grandiose self may take shape; especially when these qualities are not assimilated into the ego or they or not challenged throughout maturation!!! Such a self is often found in individuals with addictions and because such a self can be recalled it will used be used as a defense against loss of self-esteem and or loss of control. This defensiveness comes out usually at the beginning of the treatment process or is revealed when a significant other tells their partner … “Go to treatment or where done.” 31 Solowoniuk, 2007

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Rapprochement ( Toward the end of the toddler’s practicing sub-phase, he/she becomes increasing aware of his separateness from his/her MFC. Thus there will inevitably be moments when the toddler will become acutely aware of his/her complete vulnerability (falls, bumps, bruises, child becomes lost in department store, abuse at the hands of another, etc). Hence, he/she will become distressed and these frustrations and other feelings will become internalized bringing one’s omnipotence into question…. 32Solowoniuk, 2007

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Rapprochement (16 to 24 months) Here the developing self begins to understand (clearly) that causes and events exist outside of oneself, independent of his or her needs and wishes. Thus he or she suffers a lost of omnipotence and wishes to return to the safety of his/her MFC. This is a period or phase of contradictions known by the parent as a terrible two’s. http://video.google.ca/videoplay?docid=1247383557248107470&q=Terrible+Two 33Solowoniuk, 2007

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The Reemergence of Splitting : Good vs. Bad While the MFC’s will be confused by trying to understand the child's frustration, the rapprochement phase is critical to the child’s ability to internalize conflict and to reconcile clashes between an: “All Good” MFC and an “All Bad” MFC 34Solowoniuk, 2007

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The Reemergence of Splitting : Good vs. Bad (Contd) While in the symbiotic phase the MFC’s were considered “good love objects” and viewed as part of the self, they now come in conflict with the child’s new emerging sense of “I”. However, our child love objects unavoidably, have their dark sides. Sometimes they are need frustraters, or pain inflictors, or indifferent distracted caretakers, or are absent altogether. For the child’s newly developing ego, the “good MFC’s” and “bad MFC’s” can not be one and the same love object. 35Solowoniuk, 2007

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Splitting the Ego For instance, the MFC who was once so long ago apart of me, can not be bad; yet, undeniably, MFC’s are not always good. If the good MFC and the bad MFC are one person, then I, too must harbor some bad within me… That is not possible, for I’m all good. 36Solowoniuk, 2007

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Stage III Object Constancy: Reconciling the Split Within Essentially, object constancy involves the emotional and cognitive acceptance of the idea that we are neither saints nor demons but whole people capable of both love and hate. Secondly, we also understand and realize that other people are both capable of love and hate, and being able to unite and integrate such insights, individuals confirm their sense of personal wholeness. This occurs between 24 and 36 months and the degree with negotiate this stage can impact the use projection and projective identification in later life. 37Solowoniuk, 2007

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Stage III Object Constancy: Reconciling the Split Within (Contd). When object constancy is weak, the only way to protect the good, cherished parts of the self from the negative or undesirable aspects of the self is to force or split this off. Destructively, it becomes impossible to appreciate the wholeness of the self or other. Thus, the individual will simply get rid of others like unwanted objects if those others disappoint them. In addition, they will also fail to see the other’s *history of goodness and will only be able to recall the badness of the latest experience. 38Solowoniuk, 2007

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Object Constancy Achieved However, when achieved: The child can hold onto both positive and negative images of the MFC’s and function as a separate self, even if angry, frustrated, and alone(separation and individuation is achieved). There is also an enduring developing of the psychic structure; individuals are able to calm and sooth themselves and will not have to rely on external self-objects or external sources of gratification (i.e., alcohol, drugs, sex, food, and gambling, be dependent on relationships) to ward off painful affective states. 39Solowoniuk, 2007

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Addiction and Defensive Posturing Even after developing a cohesive self, the fact that a person is addicted indicates that his or her primary defenses have been weakened on one level, yet strengthened on another level. Drugs and alcohol or similar behaviors become a substitute for a person whose psychic apparatus has lost its adaptive power. And while drugs and alcohol provide temporary relief from psychic pain, deteriorating chemical effects on the mind/body result in the use of more primary defense operations like: Denial Splitting Projective identification, and: Grandiosity 40Solowoniuk, 2007

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Toward Treatment Conceptualizations While these defensive operations are attempts to shield the individual from the intolerable affects produced by the loss of self worth and other behaviors that destroy the individuals world, or… The defenses arise because of an ego that was never viable… Treatment from the psychodynamic perspective for ego related pathologies and addictions, nevertheless, follow well thought steps and time honored procedures. 41Solowoniuk, 2007

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Kernberg’s Supportive Psychodynamic Therapy Three Principles 1. Clarification of individuals behavior “this is what you are doing with me.” Distortions are confronted in a supportive, firm, and caring manner. 2. After the individual is completely aware of what they have done, gain consensual validation from group and point out how they do this with others. 3. Encourage individuals to act differently with others outside therapy. 42Solowoniuk, 2007

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Inter-Group Dynamic Corrective Emotional Process Goals Ego Strengthening ego Strengthening ego defenses for adaptive response to real life situations Examining idealized views of parents and other objects and the impact of self-absorption (who in the group remind the self of past object relations and what is being triggered). 43Solowoniuk, 2007

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Object relations Creating a new relationship template from which alternative interpretations can be made and new relationship options entertained Self-in-relations Creating a new template for mutual empathy Balancing autonomy and connection Alternative definitions of self-in-relationships Inter-Group Dynamic Corrective Emotional Process 44Solowoniuk, 2007

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General Therapist Tasks and Functions Establish trust in a therapeutic Encourage a transference relationship Interpret clients and groups: And then reflexively bridge, cycle, challenge, and offer insights derived from interpretations with the goal of group members completing a second cycle on their own. –Defenses –Counter transference –Developmental fixations –Resistance –Early relationship templates –Adaptive coping with real life –Critical relationships –Inadequate parenting –Disconnections 45 Solowoniuk, 2007

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A Brief Review of Object Related Psychodynamics Understanding relationships as specific influence in development of self Libido is object seeking Object: the target of a need or that which will satisfy a need Basic motive is to relate Focus on ego development through object relations 46Solowoniuk, 2007

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A Transference Interlude The shapes we buried, dwell about, Familiar, in the Rooms – Untarnished by the Sepulcher, The Modlering Playmate comes – In just the jacket that he wore – Long buttoned in the Mold Since we – old mornings – Children – played... The Grave yields back her Robberies – The years our pilfered things... (Emily Dickinson) 47

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Common Clues to Transference Stronger feelings than seem to fit the circumstance Instant reactions Obsession Defending others when it your issue Unexplainable attractions / repulsions Personalizing others actions, and ; A similarity in the characteristics of our partners and acquaintances Ultimately, transference shows us that other people are not out there as totally other. They are reflections/projections/ of our own story and how it played out. Instead of seeking need fulfilment in an adult way, we add on expectations and entitlements that belong to the child/parent relationship. Solowoniuk, 200748

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A Brief Review of Object Related Psychodynamics Initial relationships Single most important factor in development Constitute a template upon which others are patterned Early formation and differentiation of psychological structures that comprise images of self and others Dependency results in lack of differentiation or fusion Development moves toward independence and autonomy by means of support Problems result from developmental arrests in relationship experiences 49Solowoniuk, 2007

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The Gift of Transference and Finding the True Self When love is my only defence, I am invincible... - Tao Te Ching Solowoniuk, 200750